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Acetylcysteine

    Brands

    DEA Class;  Rx

    Common Brand Names; N-acetylcysteine, Mucomyst

    • Pulmonary, Other

    N-acetyl derivative of L-cysteine, abbreviated as NAC; possesses a strong odor, often described as rotten eggs
    Used orally or parenterally as an antidote for acetaminophen overdose to prevent hepatotoxicity
    Used via inhalation as a mucolytic agent to treat and reduce COPD exacerbations

    Acetylcysteine is used for

    • Pulmonary Disease Facilitation of expectoration via mucolysis

    • Diagnostic Bronchography

    • Acetaminophen Overdose

    • Contrast Agent-Associated Nephrotoxicity (Off-label)

      Keratoconjunctivitis Sicca (Off-label)

    • Prevention of ototoxicity caused by platinum-based chemotherapeutic agents used to treat pediatric cancers

    Acute asthma

    Documented hypersensitivity

    Skin flush (5%)

    Erythema (0.6%)

    Wheezing (0.2%)

    Increased bronchial secretions (0.2%)

    Pruritus (0.2%)

    Urticaria (0.1%)

    Wheals

    Erythema at injection site

    Bronchospasm (0.01%)

    Cyanosis (0.001%)

    Changes in heart rate (0.6-2.1%)

    Mean arterial pressure (1.9%)

    Volume of bronchial secretions may increase after administration; if cough response is inadequate, consider maintaining airway by mechanical suction if necessary; if airway block arises because of foreign body or local accumulation, clear by endotracheal aspiration, with or without bronchoscopy

    Not for injection

    Use with caution in patients with asthma or history of bronchospasm; these patients are at increased risk of hypersensitivity reactions

    In most instances, bronchospasm may be treated by prompt administration of bronchodilator via nebulization; if bronchospasm worsens, discontinue therapy immediately

    Slight disagreeable odor after administration (temporary)

    Face mask may produce sticky film on face after nebulization; remove with water

    Under certain conditions, opened bottle may cause slight purple color change as consequence of chemical reaction; this has no effect on drug safety or efficacy

    Keratoconjunctivitis: Remove contact lenses; do not coadminister with topical antibiotics

    Since increased bronchial secretions may occur after inhalation, postural drainage, inhalation percussion, and suctioning should follow; if bronchospasm occurs, administer a bronchodilator; discontinue therapy if bronchospasm progresses

    Pregnancy category: B

    Lactation: Unknown whether agent is excreted in milk; use with caution

    NOTE: Maximum dosage may vary based upon indication and route of administration. Specific maximum dosage information is not available; however, commonly used maximum doses for IV acetylcysteine are 150 mg/kg (Max: 15,000 mg) for the loading dose, 50 mg/kg (Max: 5000 mg) for the second dose, and 100 mg/kg (Max: 10,000 mg) for the third dose. Specific maximum dosage information is not available for oral or inhalational dosing.

    Adults

    Maximum dosage is not well defined.

    Geriatric

    Maximum dosage is not well defined.

    Adolescents

    Maximum dosage is not well defined.

    Children

    Maximum dosage is not well defined.

    Acetylcysteine

    Nebulizer solution

    • 10%
    • 20%